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Saturday, November 6, 2010

Henry the Eighth I am I am

I have recently spent a great deal of my time thinking about the health of Henry VIII.

This may be, in part, because I have spent a great deal of my time recently watching The Tudors from start to finish. Not to mention a long term fascination with the history of the English Royalty which is, in many myriad ways, far more entertaining than any soap opera.

I had always supposed that Henry VIII died from syphilis. This has certainly been the theory that both of my colleagues and my mother repeated to me when I mentioned that I was watching the Tudors. However as I watched the show in question dramatically detail Henry’s ailments I remembered that Jonathan Rhys Meyers is a physically rather sympathetic portrait of the good King. With the constellation of symptoms as described another diagnosis, to my mind, became much more clinically apt.

I was very gratified in the course of my research to discover that many other scholars had also come to a similar conclusion.

Henry VIII was born in 1491 the third child and second son of King Henry VII and Elizabeth of York. Of the seven children of Henry VII and Elizabeth only four survived infancy, Arthur, Margaret, Mary and, of course, Henry himself. Elizabeth herself died of childbed fever.

As the second son Henry was being groomed for a life in the church (a somewhat ironic thought if you consider his later attitude towards the institution). This changed in 1502 when his brother Arthur died. In 1509 Henry VII died and on the 24 June 1509 his son was crowned Henry VIII of England.

Henry VIII’s reign is notable for many reasons. Arguably the most memorable amongst these was his propensity for removing the heads of his political opponents, a few former friends and two of his wives. He is also notable as the catalyst for the Reformation and the modern Church of England.

Today, however, we are going to focus on Henry’s health.

When Henry took the throne he was reportedly in excellent health. At six foot four he was tall, even by today’s standards, slim and muscular. His suit of armour at this time indicates a waist measurement of somewhere between 85 and 90 centimetres with a weight roughly between 80 and 90 kilograms. Henry’s ruling style always included feats of strength and athleticism intended to prove to both his people and his enemies that his control was absolute.

Henry himself feared illness passionately. He embraced all manner of his own personal remedies and was also reported to be somewhat suspicious of his personal physicians. Given the standard of medical care at the time, however, this was probably not a wholly inappropriate attitude.

The health of the King was initially quite good. He suffered and survived a bout of smallpox at the age of 22. He also reportedly had the first of several bouts of malaria throughout his life at the age of 33. Given how rampant both infections were in England at the time neither of these are particularly remarkable.

However Henry’s athletic lifestyle eventually caught up with him.

An accident occurred in 1524 where the King forgot to close his visor during a joust with his friend Charles Brandon. A lance shattered on his open helmet causing him facial injuries. It is said that the King had chronic headaches dating from this period, although it is also possible that these headaches were related to a second more serious accident that occurred in 1536.

Jousting and King Henry, it seemed, did not agree. In 1536 King Henry was again injured in an accident while in the lists. His horse fell heavily across him severely injuring his leg and knocking him unconscious for two hours. Such was the worry for his life that while he lay unresponsive his advisors were moving both paperwork and armed soldiers to ensure the succession of his then heir, the Princess Elizabeth, over the older daughter, Princess Mary, who at this time had been declared illegitimate.

Queen Anne, then about 20 weeks pregnant, was so shocked by the news that she collapsed. She blamed this scare for the costly miscarriage of a male infant that occurred six days later.

King Henry regained consciousness. However it would be incorrect to say that he completely recovered. The wound on his leg became infected and it never completely healed. Although on occasion it would temporarily close over, for the most part it would continue to fester for the rest of his life. He began to suffer from insomnia and crippling migraine headaches. He also developed gout.

His personality began to change. He became paranoid and depressed with wild mood swings and a notorious temper. He began to binge eat a diet solely consisting of protein and fat, supposedly to control his stress. His weight increased significantly. A suit of armour dating from this period of his life gives him a waist measurement of between 145 and 152cm and a weight between 136 and 145 kilograms. Male courtly fashions during this period contained a significant amount of padding to emulate the King’s increasing girth.

(King Henry's suit of armour from later in life. Photo by me)

The ulcers were now on both of King Henry’s legs and stank. It is perhaps not surprising that the 17 year old Catherine Howard commenced an affair with the younger and less purulent Thomas Culpepper, even if it did result in the removal of her head.

The King’s health continued to decline significantly. In the final few years of his life he had a series of what were most likely strokes, resulting in even more mental decline.

He died on the 28 January 1547 at the age of 56. Fifty-six was actually quite an advanced age for the Tudor period. However it was not a pretty death. Such was the degree of infection in the King’s lower limbs that he was unable to move from the bed and the putrid smell of gangrene hung over the entire room. Due to a law that made discussing the death of the King treason not one of Henry’s doctors or courtiers were able to inform the King that his end was drawing near. The Archbishop Thomas Cranmer was eventually called to attend and bravely gave the grim news.

The King’s final words, likely indicative of a delirium, were reportedly, “Monks! Monks! Monks!”

The popular theory has always been to surmise that the death of the King was due to syphilis. Syphilis was rampant in the city of London during the King’s reign and it is certainly possible that he could have been exposed. Scholars point to the sores on the King’s legs and his mental decline as possible markers of the illness. A syphilitic infection is also commonly associated with an increased rate of miscarriage and birth defects which may perhaps explain the difficulties the King had in producing the male heir he desperately desired.

This also satisfies the perception of Henry VIII as a wholly lascivious monarch.

This explanation, though titillating, does not completely fit the facts as we know them today.

Firstly the very fact that syphilis was widespread meant that even in the 1500s it was a well described condition. The King’s physicians would certainly have been aware of the disease and how it presented, yet no mention of syphilis is made in their notes about the King. The theory itself was first mentioned some one hundred years after the death of Henry.

Secondly the fate of the progeny of Henry does not necessarily make compelling evidence. Catherine of Aragorn had six pregnancies. Two of these were stillbirths and two children died after only a few hours. One son, Henry, lived for 52 days and a daughter, the future Queen Mary I, survived into adulthood. Anne Boelyn firstly bore the healthy and future queen, Elizabeth, followed by three miscarriages. (Read more about her here). Jane Seymour, the King’s third wife, was pregnant only once and delivered of a healthy boy, the future King Edward, a process that resulted in her own death. (Read more about her here).

While his wives certainly had their share of misfortune in their obstetric histories, none of this is particularly unusual for the period. With such poor levels of hygiene, nutrition, health and a complete lack of obstetric intervention, rates of perinatal death were always quite high, no matter if the woman carrying the child was of high birth or low. In addition the King was already in his forties by the time he married Anne Boelyn. Of Henry’s three adult children there is no evidence in the record of congenital syphilis. Quite the opposite, as Edward and Mary were both reasonably capable rulers in their own right and the Queen Elizabeth is arguably one of the greatest monarchs in English history.

In addition the King’s final wife, Catherine Parr, while not falling pregnant during her marriage to the king, did do so unexpectedly at the age of 35 during her subsequent marriage to Thomas Seymour. She delivered a child named Mary Seymour who died in childhood (probably around the age of 2) and then subsequently died herself of childbed fever. Were the King to have infected Catherine with syphilis such an unexpected pregnancy seems quite unlikely.

Finally even the image of the King as promiscuous is perhaps not entirely fair. Henry VIII was certainly married to six women, and claimed only to have slept with five of them, but only had two mistresses that historians agree on, namely Bessie Blount and Mary Boelyn.

The King certainly may have taken many more than this to his bed, but if he did so then he was very discreet about it.

While syphilis is an attractive and entertaining theory, another diagnosis seems to fit the bill more closely with the benefit of a more modern understanding of the human body.

King Henry VIII very likely had untreated type 2 diabetes.

Type 2 diabetes is a disorder of decreased insulin secretion associated with insulin resistance whereby the body’s tissues are less able to respond to the hormone even when it is present. It is a disorder that affects every system of the body, resulting in a variety of complications from heart attacks to strokes to blindness and to kidney failure.

Significantly, in the case of the King, it often causes poor circulation and sensation in the lower limbs resulting in the increased likelihood of infections and slow healing. Henry’s initial ulcer and its recurrences throughout his life may in fact be a sign of osteomyelitis, or infection in the underlying bone, again a common complication of diabetes.

Of course diabetes is significantly worsened in the face of obesity, poor diet and inactivity. Henry after his jousting accident led a very sedentary lifestyle and ate much as he pleased as his ever increasing girth will testify. This no doubt slowed the healing of his ulcers even further and led to the creation of even more.

It is also possible that the non-consummation of the King’s marriage to Anne of Cleves resulted from another known complication of diabetes, erectile dysfunction, although there is of course no way to know for certain.

The King’s deterioration in mental state can also be attributed to a diagnosis of diabetes and the series of strokes he was said to have suffered. Tellingly his sister, the Princess Margaret, also suffered a series of strokes and a mental decline in her final years.

In addition to this possible explanation is also the fact that the King suffered an injury in 1536 that was severe enough to leave him unconscious for two hours. It is not inconceivable to expect that he may have suffered a head injury severe enough to result in a change of personality. The King’s increasingly erratic and domineering behaviour could perhaps be partially explained by the fact that in defying the Pope he had realised that his rule was absolute and without challenge. However a brain injury, in particular one to the frontal lobe, can often result in a loss of impulse control.

Henry, previously the charismatic courtier, certainly had a great deal of difficulty with impulse control in the later part of his life. Witness, amongst other decisions, the execution of Sir Thomas Cromwell, an impulse the King later regretted.

Had Henry VIII lived today his diabetes could have been controlled with medication and synthetic insulins. His infection could have been treated with antibiotics or, if necessary, amputation. His strokes may have been prevented with medication and better control of his diabetes. While one cannot say anything for certain, it is likely that he might have been able to live a longer and more comfortable life.

Of course, given his propensity for the removal of heads, perhaps England as a whole was fortunate that the reign of Henry VIII did eventually come to an end, however ignoble that end may have been.

There is no way of telling for sure if this diagnosis, more than any other, is correct. King Henry VIII’s body was exhumed in 1812, but was not examined, and modern testing was not available at that stage. Even would the Queen allow for an exhumation on the grounds of idle curiousity there would be no way in which to determine for certain if diabetes was the cause of his death, although it would answer the syphilis question. Definitive answers would also derail any chance at continued speculation.

Thanks so much for this article! I'm absolutely obsessed with Henry VIII and all his shenanigans. I'm in the middle of reading Philippa Gregory's series of 'Bolyn' books. I realize they are historical fiction, loosely based on fact. As a nurse, I have found myself wondering what made Henry's leg wound(s) smell so bad - psudomonas? Gangrene? (as you stated). Furthermore, how could he live so long and be so active with those awful wounds? Amazing guy, but creepy at the same time.

I found during some research that, a King couldn't be a King if he was not "whole". (I haven't been able to completely verify if this as fact of fiction). Meaning a King would be unable to rule the country if a limb was amputated. Possibly a reason this option wasn't presented to the King. More likely the option wasn't given because the Physicians were fearful of their own heads becoming amputated.

Lorraine,what you mean you dont understand why his wounds smelled,your a so called nurse and you don't understand,lol how pathetic Henry wounds stunk because they kept getting infected over and over again,they wasn't healing right,duh you don't have to be a nurse to figure that out,if they would have clean the wounds everyday,put medicine on the wounds,and he take it easy and don't put wrap the bandages so tight using fresh ones,and he dont put pressure on it,then they could've healed,or cut it off,bottom line,what goes around comes around that's fact he suffered in the end because he was a nasty ass man,killing Anne leaving her baby Elizabeth alone,he was a liar,stuck up,he cheated but wouldn't allow his wives to do it,cheating wrong but he did it why couldn't they,he treated his daughters like they wasn't his over a son how lame,Elizabeth showed his ass she ruled better than him and she was strong and lived longer she did great job and I will always respect her,Henry VIII reaping came to haunt his ass,he did alot of bad shit to people,I didn't fill sorry for him one bit when you bad evil shit to people it makes bad to you,that's a fact

You are judging a sixteenth century king by twenty-first ordinary man standards. The prevailing view in the sixteenth century amongst all people was that infidelity was a far more heinous offense in a wife than in a husband. It was accepted by everyone in the sixteenth century, women as well as men, that women were the inferior sex. Henry VIII was a King of England, and as such, he was aware that the only previous time that a King of England had tried to leave the throne to his daughter (when Henry I attempted to leave the throne to his daughter Matilda), it had resulted in a civil war. So naturally he thought that to do so was impossible, so naturally he thought that he must have a legitimate son. Of course, it is ironic that his daughter Elizabeth became a great queen, but he had no way of knowing that such a thing was possible, based upon history. Of course, he was egotistical, all kings were, it was a result of that system of government. Yes, he did some cruel things, so I'm not defending him entirely. However, he also did some great things, and you ARE taking him out of context. It's not black and white.

Apologies in advance all around, but I've got to know what "Indian Sage"'s bottom line theory is for the reason King Henry VIII's wounds smelled er, putrified.Was it because he led (in his/her opinion) a morally decrepit life and he left his children alone or was it because he had a physical issue? Or both? Had he lived a more moral life, and been a nicer guy, would his wounds not have stunk so badly? Could a 'nice guy' ever stink - or is stinking just reserved for bad people?And shouldn't a Nurse know at least that much to be able to tell the difference to know who deserves better care in the event that faced with two patients (and only one stinks) which patient to care for? I always thought decisions like that were a Doctor's call, but maybe you know something I don't.Is this why my Mother always told me to put clean underwear on before leaving the house in case I got hit by a car and had to go to the ER, I wouldn't get medical testament otherwise?

In my opinion, hypopituitaryism could cause both diabetes (mellitus) and all the other symptoms while being consistent with head trauma - especially with loss of conscience.If the pituitary were injured to the degree that the endocrine system would change it's ability to handle insulin resistance, it would also allow for lack of adrenal function, sex hormone production, thyroiditis and decreased ability to heal for lack of human growth hormone, and all that implies.If it was either diabetes 2 alone or hypopituitaryism - either would result in a terrible, sometimes longish period of zero quality of life finally followed by a horrible, albeit welcomed death. Especially during his time where no treatment were available. I know it's just my theory, but it's not that far from your own.Have you considered it?

Oh shut up you wasn't there,Henry could've been 6'3 you were not there so stop the drama,other books,documentation,video on him says the same thing,and I'm sure when making his outfits of course they knew his height,you can tell in his clothes and portraits he was tall,so get your facts straight I've never heard of him being 6'1 still tall,but many facts and resources say he was 6'3 even people recorded stating him at 6'3 just because you dont believe it doesn't make it true,omg people today,

Alison Weir hypothesizes that Katherine of Aragon's gynecological difficulties may have stemmed from the very thing the deeply religious queen did to try to ensure the successful birth of a male heir: she fasted obsessively, exactly the opposite of the good nutrition required for a healthy child.

As for Anne Boleyn, it is surmised by some that she was Rh negative, and had problems with all but her first pregnancy because of that.

Really enjoyed this read! It has been suggested that is was the first jousting injury that possibly resulted in some type of brain injury (when he was struck in the head above the eye by a jousting stick while riding with his helmet open). Reports say that Henry's personality changed after the accident, that he became paranoid, tyrannical, and violent in the following years. I also believe that he suffered further brain trauma in a second jousting accident where his legs were badly damaged and he laid unconscious for 2 hours. This second accident was the beginning of the end for Henry as his many health issues (from the ulcerous wounds on his legs) may have caused blood sepsis and this could also have affected his reasoning.

Perhaps you have heard by now of the theory that Henry VIII was Kell-positive, and that this was the reason behind his inconsistent reproductive history? His paranoia and mental/emotional instability could also have been due to McLeod Syndrome, also unique to Kell-positive people.

His head injuries and likely diabetes almost certainly played a role as well, but the Kell-positive issue is an alternative to the Rh- theory that floats around and explains a lot more, including the transformation of his personality. You can read more about it here:

As yet another Tudor enthusiast, I enjoyed this article very much. As a medical transcriptionist for over 30 years, I thought it was a very possible hypothesis. Also, some people above could be a bit nicer...

Just watched final episode of the series. Enjoyed it thoroughly and wish it would have kept on going right through until Elizabeth's reign even. Your article was fascinating thank you for posting really helped me to better understand the medical condition as I was most curious about the sufferings of his leg. On to finding another series to watch on Netflix :)

I think this piece goes into an above and beyond evaluation of Henry XIII's health. The theory that he may have had untreated diabetes was particularly interesting, and I liked the arguments you brought to the table there. There's a kind of fun in speculation, and I think you recognize that. Interesting read.